Definitions
Health Technology refers here to the equipment, drugs and procedures used by health care professionals, and the systems within which they are used.
Health Technology Assessment (HTA) consists of a synthesis of the evidence concerning the effectiveness, risks, and costs of health technology, together with a review of any relevant ethical and legal issues. It will usually include policy recommendations.
A mini-Health Technology Assessment (mini-HTA) is a report prepared by the professional staff of TAU, either in response to an urgent request for evidence, when there is relatively little evidence available or when the budget impact of the technology is small. It usually consists of a brief review of the available evidence and does not include policy recommendations. Though internally reviewed it is usually not submitted to external reviewers or to the Policy Committee.
The McGill University Health Centre MUHC is a single corporate structure including six hospital sites, the Montreal Children's Hospital (MCH), the Montreal General Hospital (MGH), the Montreal Chest Institute (MCI), the Montreal Neurological Hospital (MNH), the Lachine General Hospital and the Royal Victoria Hospital (RVH).
Background
The health care system cannot afford to provide unlimited health services to everyone irrespective of the cost. Accordingly, access to some services must be given priority, and access to others must be limited.
Some decisions to limit services are at present taken by governments (for example, the decision not to provide optometric or dental services). However, many such decisions are taken within hospitals. Although governments claim to provide access to all "necessary" in-hospital health services, hospitals must function within fixed global budgets. Thus hospitals must make choices, prioritize.
Objective
To assist the hospital in this task, the MUHC has created the TAU to prepare accurate and trustworthy evidence to inform decision-making and when necessary to make policy recommendations based on this evidence. The objective is of the TAU is to advise the hospitals in difficult resource allocation decisions, using an approach based on sound, scientific technology assessments and a transparent, fair decision-making process. Consistent with its role within a university health centre, it publishes its research when appropriate, and contributes to the training of personnel in the field of health technology assessment.
Principles
- The TAU is advisory.
- Responsibility for decision making is unchanged.
- To assist the hospital decision makers TAU develops two distinct products:
- Health Technology Assessments. Decisions concerning the acquisition or continuing use of a technology should be informed by reliable estimates of the efficacy and costs of that technology, and by an awareness of any legal or ethical issues that may be relevant to its acquisition. All TAU reports provide such technology assessments.
- Policy Recommendations. Most reports also include policy recommendations. Resource allocation decisions cannot be taken on the basis of the objective data provided by HTAs alone. They are determined also by the values of the decision-makers. For decisions to be accepted and supported by the hospital community, they should be consistent with the values of that community. Thus, for the purpose of developing Policy Recommendations based on the objective evidence, the hospital has created the TAU Policy Committee, a body that is representative of the hospital community and sensitive to its values.
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Transparency is essential for the acceptance of decisions.
Policy recommendations together with the data and the reasoning behind them are not only submitted to the hospital's decision-making authority but are also widely distributed and put on the web.
Governance
The TAU is administered by a Director who is responsible to the Policy Committee that is representative of the different disciplines and different hospital sites that make up the MUHC. The Policy Committee in turn reports to the MUHC through the Director General.
Process
TAU Flow Chart [.pdf] TAU FLOW CHART OF HTA PROCESS
The TAU uses the following process when developing reports.
Topic
The topics chosen for review are those that involve a difficult decision, usually due to high costs or uncertain clinical benefits. Most reviews are developed at the request of the hospital administration, the clinical and administrative departments, and the hospital community.
The decision to accept a topic for review is made on the grounds of such factors as contentiousness, a potentially large economic impact, marginal effectiveness, an unfavourable cost-effectiveness ratio, or uncertainty as to the reliability of the evidence of benefit or side-effects.
Issues are not usually reviewed except at the request of, or with the concurrence of, the hospital administration. To avoid duplication of effort, databases of completed and ongoing technology assessments by other agencies are searched before each new project is initiated.
Local involvement
At an early stage and throughout the review process, there is involvement of the departments or disciplines responsible for the technology in question. Members from that department or discipline are co-opted by the Policy Committee for the duration of the study in question.
Communication
Technology Assessments or Policy Recommendations are submitted to the hospital authorities and are made public to the hospital community, with a clear account of the data and reasons on which the recommendations are based. Reports are made available to organizations and hospitals for which the topic might be relevant and are posted on the TAU website. Also, where appropriate, reports are edited and submitted to professional journals.
Evaluation
The TAU conducts a regular follow-up of each Technology Assessment or Policy Recommendation that it submits, so as to document their impact on hospital policy.
Updates
The TAU regularly reviews its reports and where appropriate (e.g. because of new evidence or changing clinical practice) reexamines the evidence and publishes an update.